Skip to main content
SpringerLink
Log in

Non-alcoholic Fatty Liver Disease (NAFLD) and Bariatric Surgery

  • Chapter
Obesity, Bariatric and Metabolic Surgery

  • 3134 Accesses

Abstract

Morbid obesity is associated with debilitating conditions that adversely affect quality of life and increase the risk of premature death including the metabolic syndrome (hypertension, hypercholesterolemia, type 2 diabetes mellitus (T2DM)) and non-alcoholic fatty liver disease (NAFLD). Insulin resistance is almost a universal finding in patients with NAFLD with majority suffering from T2DM. NAFLD was found to be present in more than 67 % of overweight patients (body mass index (BMI) more than 25 kg/m2) and nearly in 94 % of obese patients (BMI more than 30 kg/m2). NAFLD is a common cause of chronic liver disease worldwide. Simple fatty liver disease (steatosis) is a benign condition, reversible by weight loss. Inflammatory cell infiltration leading to non-alcoholic steatohepatitis (NASH) is a more aggressive condition, which is present in up to 10 % of cases and may lead to varying degree of fibrosis and cirrhosis or hepatocellular cancer (HCC) in up to 2 % of this at risk population. However, NASH and hepatic fibrosis short of cirrhosis cannot be reliably diagnosed clinically, radiographically, biochemically or even on gross examination intraoperatively, making liver biopsies the only reliable way to evaluate the liver status. Bariatric surgeons encounter NAFLD in 85–95 % of morbidly obese patients and thus have the unique opportunity to diagnose and assess severity of NAFLD by conducting an intraoperative liver biopsy in morbidly obese patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Lazo M, Clark JM. The epidemiology of nonalcoholic fatty liver disease: a global perspective. Semin Liver Dis. 2008;28(4):339–50.

    Article  PubMed  Google Scholar 

  2. Younossi ZM, Stepanova M, Afendy M, Fang Y, Younossi Y, Mir H, et al. Changes in the prevalence of the most common cause of liver diseases in the United States from 1988 to 2008. Clin Gastroenterol Hepatol. 2011;9(6):524–530.e1; quiz e60.

    Article  PubMed  Google Scholar 

  3. Fisher BL, Schauer P. Medical and surgical options in the treatment of severe obesity. Am J Surg. 2002;184(6B):9S–16.

    Article  PubMed  Google Scholar 

  4. Sjostrom L, Narbro K, Sjostrom CD, Karason K, Larsson B, Wedel H, et al. Swedish Obese Subjects Study. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.

    Article  PubMed  Google Scholar 

  5. Anstee QM, Daly AK, Day CP. Genetic modifiers of non-alcoholic fatty liver disease progression. Biochim Biophys Acta. 2011;1812(11):1557–66.

    Article  CAS  PubMed  Google Scholar 

  6. Anstee QM, Targher G, Day CP. Progression of NAFLD to diabetes mellitus, cardiovascular disease or cirrhosis. Nat Rev Gastroenterol Hepatol. 2013;10(6):330–44.

    Article  CAS  PubMed  Google Scholar 

  7. Kleiner DE, Brunt EM, Van Natta M, Behling C, Contos MJ, Cummings OW, et al. Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology. 2005;41(6):1313–21.

    Article  PubMed  Google Scholar 

  8. Chalasani N, Younossi Z, Lavine J, Diehl AM, Brunt EM, Cusi K, et al. The diagnosis and management of non-alcoholic fatty liver disease: practice guideline by the American Association for the Study of Liver Diseases, American College of Gastroenterology, and the American Gastroenterological Association. Am J Gastroenterol. 2012;107(6):811–26.

    Article  PubMed  Google Scholar 

  9. Vernon G, Baranova A, Younossi ZM. Systematic review: the epidemiology and natural history of non-alcoholic fatty liver disease and non-alcoholic steatohepatitis in adults. Aliment Pharmacol Ther. 2011;34(3):274–85.

    Article  CAS  PubMed  Google Scholar 

  10. Haring R, Wallaschofski H, Nauck M, Dörr M, Baumeister SE, Völzke H. Ultrasonographic hepatic steatosis increases prediction of mortality risk from elevated serum gamma-glutamyl transpeptidase levels. Hepatology. 2009;50(5):1403–11.

    Article  PubMed  Google Scholar 

  11. Tahan V, Canbakan B, Balci H, Dane F, Akin H, Can G, et al. Serum gamma-glutamyltranspeptidase distinguishes non-alcoholic fatty liver disease at high risk. Hepatogastroenterology. 2008;55(85):1433–8.

    CAS  PubMed  Google Scholar 

  12. Matteoni C, Younossi Z, Gramlich T, Boparai N, Liu YC, McCullough AJ. Nonalcoholic fatty liver disease: a spectrum of clinical and pathological severity. Gastroenterology. 1999;116(6):1413–9.

    Article  CAS  PubMed  Google Scholar 

  13. Harrison SA, Oliver D, Arnold HL, Gogia S, Neuschwander-Tetri BA. Development and validation of a simple NAFLD clinical scoring system for identifying patients without advanced disease. Gut. 2008;57(10):1441–7.

    Article  CAS  PubMed  Google Scholar 

  14. Sterling RK, Lissen E, Clumeck N, Sola R, Correa MC, Montaner J, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology. 2006;43(6):1317–25.

    Article  CAS  PubMed  Google Scholar 

  15. Vallet-Pichard A, Mallet V, Nalpas B, Verkarre V, Nalpas A, Dhalluin-Venier V, et al. FIB-4: an inexpensive and accurate marker of fibrosis in HCV infection. Comparison with liver biopsy and FibroTest. Hepatology. 2007;46(1):32–6.

    Article  CAS  PubMed  Google Scholar 

  16. Shah AG, Lydecker A, Murray K, Tetri BN, Contos MJ, Sanyal AJ. Use of the FIB4 index for non-invasive evaluation of fibrosis in nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2009;7(10):1104–12.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Angulo P, Hui JM, Marchesini G, Bugianesi E, George J, Farrell GC, et al. The NAFLD fibrosis score: a noninva- sive system that identifies liver fibrosis in patients with NAFLD. Hepatology. 2007;45(4):846–54.

    Article  CAS  PubMed  Google Scholar 

  18. Quereshy K, Clements RH, Abrams GA. The utility of the “NAFLD fibrosis score” in morbidly obese subjects with NAFLD. Obes Surg. 2008;18(3):264–70.

    Article  Google Scholar 

  19. Cales P, Laine F, Boursier J, Deugnier Y, Moal V, Oberti F, et al. Comparison of blood tests for liver fibrosis specific or not to NAFLD. J Hepatol. 2009;50(1):165–73.

    Article  PubMed  Google Scholar 

  20. Loaeza-del-Castillo A, Paz-Pineda F, Oviedo-Cardenas E, Sanchez-Avila F, Vargas-Vorackova F. AST to platelet ratio index (APRI) for the noninvasive evaluation of liver fibrosis. Ann Hepatol. 2008;7(4):350–7.

    CAS  PubMed  Google Scholar 

  21. McPherson S, Stewart SF, Henderson E, Burt AD, Day CP. Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease. Gut. 2010;59(9):1265–9.

    Article  PubMed  Google Scholar 

  22. Neuschwander-Tetri BA, Clark JM, Bass NM, Van Natta ML, Unalp-Arida A, Tonascia J, et al. Clinical, laboratory and histological associations in adults with nonalcoholic fatty liver disease. Hepatology. 2010;52(3):913–24.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  23. Powell EE, Cooksley WG, Hanson R, Searle J, Halliday JW, Powell LW. The natural history of nonalcoholic steatohepatitis: a follow-up study of forty-two patients for up to 21 years. Hepatology. 1990;11(1):74–80.

    Article  PubMed  Google Scholar 

  24. Shalhub S, Parsee A, Gallagher SF, Haines KL, Willkomm C, Brantley SG, et al. The importance of routine liver biopsy in diagnosing nonalcoholic steatohepatitis in bariatric patients. Obes Surg. 2004;14(1):54–9.

    Article  PubMed  Google Scholar 

  25. Mosko J, Nguyen G. Increased perioperative mortality following bariatric surgery among patients with cirrhosis. Clin Gastroenterol Hepatol. 2011;9(10):897–901.

    Article  PubMed  Google Scholar 

  26. Miele L, Forgione A, Gasbarrini G, Grieco A. Noninvasive assessment of fibrosis in non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). Transl Res. 2007;149(3):114–25.

    Article  CAS  PubMed  Google Scholar 

  27. Dyson JK, McPherson S, Anstee QM. Non-alcoholic fatty liver disease: non-invasive investigation and risk stratification. J Clin Pathol. 2013;66(12):1033–45.

    Article  CAS  PubMed  Google Scholar 

  28. Padoin AV, Mottin CC, Moretto M, Berleze D, Kupski C, Glock L, et al. A comparison of wedge and needle hepatic biopsy in open bariatric surgery. Obes Surg. 2006;16(2):178–82.

    Article  PubMed  Google Scholar 

  29. Brolin RE, Bradley LJ, Taliwal RV. Unsuspected cirrhosis discovered during elective obesity operations. Arch Surg. 1998;133(1):84–8.

    Article  CAS  PubMed  Google Scholar 

  30. Teixira AR, Belodi-Privato M, Carvalheira JB, Pilla VF, Pareja JC, D’Albuquerque LA. The incapacity of the surgeon to identify NASH in bariatric surgery makes biopsy mandatory. Obes Surg. 2009;19(12):1678–84.

    Article  Google Scholar 

  31. Society of American Gastrointestinal and Endoscopic Surgeons (SAGES): Guideline for clinical application of laparoscopic bariatric surgery. 2008. Available from: http://www.sages.org/publications/guidelines/guidelines-for-clinical-application-of-laparoscopic-bariatric-surgery/.

  32. Mathurin P, Hollebecque A, Arnalsteen L, Buob D, Leteurtre E, Caiazzo R, et al. Prospective study of the long-term effects of bariatric surgery on liver injury in patients without advanced liver disease. Gastroenterology. 2009;137(2):532–40.

    Article  CAS  PubMed  Google Scholar 

  33. Liu X, Lazenby AJ, Clements RH, Jhala N, Abrams GA. Resolution of nonalcoholic steatohepatits after gastric bypass surgery. Obes Surg. 2007;17(4):486–92.

    Article  PubMed  Google Scholar 

  34. Barker KB, Palekar NA, Bowers SP, Goldberg JE, Pulcini JP, Harrison SA. Non-alcoholic steatohepatitis: effect of Roux-en-Y gastric bypass surgery. Am J Gastroenterol. 2006;101(2):368–73.

    Article  PubMed  Google Scholar 

  35. de Freitas AC, Campos AC, Coelho JC. The impact of bariatric surgery on nonalcoholic fatty liver disease. Curr Opin Clin Nutr Metab Care. 2008;11(3):267–74.

    Article  PubMed  Google Scholar 

  36. Chavez-Tapia NC, Tellez-Avila FI, Barrientose-Gutierrez T, Mendez- Sanchez N, Lizardi-Cervera J, Uribe M. Bariatric surgery for non-alcoholic steatohepatitis in obese patients. Cochrane Database Syst Rev. 2010;(1):CD007340.

    Google Scholar 

  37. Mummadi RR, Kasturi KS, Chennareddygair S, Sood GK. Effect of bariatric surgery on nonalcoholic fatty liver disease: systematic review and meta-analysis. Clin Gastroenterol Hepatol. 2008;6(12):1396–402.

    Article  PubMed  Google Scholar 

  38. Cotler SJ, Vitello J, Guzman G, Testa G, Benedetti E, Layden TJ. Hepatic decompensation after gastric bypass surgery for severe obesity. Dig Dis Sci. 2004;49(10):1563–8.

    Article  PubMed  Google Scholar 

  39. Lim RB, Blackburn GL, Jones DB. Benchmarking best practices in weight loss surgery. Curr Probl Surg. 2010;47(2):79–174.

    Article  PubMed Central  PubMed  Google Scholar 

  40. Omalu BI, Ives DG, Buhari AM, Lindner JL, Schauer PR, Wecht CH, Kuller LH. Death rates and causes of death after bariatric surgery for Pennsylvania residents, 1995 to 2004. Arch Surg. 2007;142(10):923–8.

    Article  PubMed  Google Scholar 

  41. Östlund MP, Marsk R, Rasumssen F, Lagergren J, Näslund E. Morbidity and mortality before and after bariatric surgery for morbid obesity compared with the general population. Br J Surg. 2011;98(6):811–6.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, Sunderland Royal Hospital, Sunderland, UK

    Shlok Balupuri MBBS, FRCS, MD & Kamal K. Mahawar MS, MSc, FRCSEd

  2. Division of Gastroenterology, Department of Medicine, University of Toronto, Toronto, ON, Canada

    Angela C. Cheung BSc, MD

  3. Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK

    Quentin M. Anstee BSc(Hons), MB BS, PhD, MRCP

Authors
  1. Shlok Balupuri MBBS, FRCS, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Angela C. Cheung BSc, MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kamal K. Mahawar MS, MSc, FRCSEd
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Quentin M. Anstee BSc(Hons), MB BS, PhD, MRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shlok Balupuri MBBS, FRCS, MD .

Editor information

Editors and Affiliations

  1. Homerton University Hospital, London, United Kingdom

    Sanjay Agrawal

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Balupuri, S., Cheung, A.C., Mahawar, K.K., Anstee, Q.M. (2016). Non-alcoholic Fatty Liver Disease (NAFLD) and Bariatric Surgery. In: Agrawal, S. (eds) Obesity, Bariatric and Metabolic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-04343-2_69

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-04343-2_69

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-04342-5

  • Online ISBN: 978-3-319-04343-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation